I'm wondering if anyone here has been tested and has low androgen levels? I know that many are within normal range, but I'm talking about those whose androgens are at the low end or below the normal range for adult women. I recently had very thorough bloodwork and urine analysis done, and all of my androgens are at the low end, or below normal. Yet I have chronic acne around my chin and facial hair, and a high sex drive. It's mind boggling, but the endocrinologist says most likely it is overactive enzymes at the skin level. There is no way to test for that unless doing a biopsy.

Anyway, I am really wanting to try Spiro again. I tried it for 1 week and quit when I broke out in cysts, which is very unusual for me. They all subsided when I quit, except for one which is still under the skin 2.5 months later. My fear is that I do not have sufficient androgens to activate Spiro's anti-androgen properties. I have researched extensively and here is what I have found:

Spiro is not a "pure" blocker (antagonist) of the androgen receptor. It actually contains properties that act pro-androgen (agonist) thereby activing the receptor (NOT what we want). However, in the presence of enough testosterone (which is a full agonist of the androgen receptor), spiro acts as an antagonist (yay!). This is because when there is a full agonist present (Testosterone, DHT), a partial agonist (spiro) will act as an antagonist by competing with the agonist for the receptor, and essentially winning. Clinical studies have shown that normal ranges for females contain enough testosterone to make this happen. When such competition is lacking, spiro may behave as an agonist and create androgenic effects.

So my fear is that I do not have enough testosterone to make Spiro work. I am afraid I will spend months bearing through the "IB" only to never have success at all, and have more scarring. But then i'm thinking maybe I have enough at the skin level, however I'm not sure whether this impacts Spiro's behaviour. I have read through hundreds of posts on spiro and I did find one user who said she had low testosterone, was on Spiro for a year, and it never worked. So I am just hoping someone else can chime in.

Have you thought about bioidentical progesterone? Progesterone is a regulator hormone. If you have an estrogen dominance problem, which it sounds like you do, it can hopefully scale back the estrogen which might help fix your other hormonal issues.

Personally though I think Spiro could still work, simply because it has also been shown that once an androgen receptor is "sensitized" that it will still respond negatively even if your actual levels are low. This makes a lot of sense because spiro often works for women with normal or low testosterone levels.

Spiro obviously won't fix your low testosterone, but by blocking your sensitized receptors it would at least help with the acne.

Thanks for responding! My androgen receptors have definitely been "sensitized", or rather the enzymes in my skin that convert testosterone to DHT are overactive. So yes, IF spiro would work then it would definitely help me. My fear is that I lack the necessary testosterone to make spiro work. I was actually reading that partial agonists like Spiro are used to activate receptors in the absence of a full agonist. So in the absence of sufficient testosterone, spiro would have the opposite effect and imagine how terrible that would be.

As for estrogen dominance, I'm not sure about that as all my hormones are low. I remember taking progesterone suppositories in the beginning of my pregnancy and having the worst acne. Of course hormones are so chaotic at the beginning of pregnancy that who knows if that was the cause.

Thanks for responding! My androgen receptors have definitely been "sensitized", or rather the enzymes in my skin that convert testosterone to DHT are overactive. So yes, IF spiro would work then it would definitely help me. My fear is that I lack the necessary testosterone to make spiro work. I was actually reading that partial agonists like Spiro are used to activate receptors in the absence of a full agonist. So in the absence of sufficient testosterone, spiro would have the opposite effect and imagine how terrible that would be.

As for estrogen dominance, I'm not sure about that as all my hormones are low. I remember taking progesterone suppositories in the beginning of my pregnancy and having the worst acne. Of course hormones are so chaotic at the beginning of pregnancy that who knows if that was the cause.

Your progesterone suppositories may have contained progestin, not progesterone. Progestin (synthetic progesterone) is processed differently by the body. There are many different "brands" of progestin, and many are androgenic and cause acne.

Yes, spiro as a partial agonist can theoretically act as an agonist IF your androgen levels are EXTREMELY low, and at a sufficiently high dose. That last bit is key, I think, because 50-150mg, which is the normal dosing range for women, is not really a "high dose". I think you would have cause to be worried if you were taking 200+mg.

You know you are probalby right about the Spiro. Otherwise way more people would have bad effects from it I would think. Did you have an IB with Spiro? I just don't know if I can handle it - I am still recovering from the one it gave me almost 3 months ago. Good point about the progesterone suppositories too. Now I am wishing my endo tested my progesterone and estrogen when I was there too...

You know you are probalby right about the Spiro. Otherwise way more people would have bad effects from it I would think. Did you have an IB with Spiro? I just don't know if I can handle it - I am still recovering from the one it gave me almost 3 months ago. Good point about the progesterone suppositories too. Now I am wishing my endo tested my progesterone and estrogen when I was there too...

No I didn't get an IB, but I had to suffer through 4 months of "no change" because I was being stubborn and didn't take any "helpers" (antibiotics, topicals, etc.) I was really emotionally fed up with my acne, so I did spiro in isolation to "prove" if it worked or not...

If you're worried about an IB, just start at the lowest possible dose and work very gradually. I was on 50mg for a month before I bumped up to 100mg. If you're more sensitive start at 25mg for a month or two and see how it goes. You can even go smaller, cut your 25mg in half.

Yeah I don't have PCOS, or adrenal hyperplasia, or Cushings...I have very low testosterone and Free testosterone, yet I have facial hair. So he figures it is the enzymes in the skin.

That was brave of you to not use any helpers haha. I am not so brave and will go full throttle with antibiotics and topicals if I start up again. What dosage did you start on? I'm conflicted because some people say they get an IB everytime they up their dose, so I wouldn't want to go through that. But I wouldn't want to start on a mega dose and have a mega IB either.

Yeah I don't have PCOS, or adrenal hyperplasia, or Cushings...I have very low testosterone and Free testosterone, yet I have facial hair. So he figures it is the enzymes in the skin.

That was brave of you to not use any helpers haha. I am not so brave and will go full throttle with antibiotics and topicals if I start up again. What dosage did you start on? I'm conflicted because some people say they get an IB everytime they up their dose, so I wouldn't want to go through that. But I wouldn't want to start on a mega dose and have a mega IB either.

Also, what brand do you use? Mine is the qualitest generic..

Started on 50mg, went to 100mg after a month.

Mine is also the Qualitest generic. If you're sensitive, switch to the Aldactone brand name, it's not that much more expensive (about $10).

Mine is the Amneal. I don't think it's as effective as other brands I've tried :/ Do you guys pay full price or do you have insurance?

Morning:Cerave foaming face wash in shower. Moisturize with Cerave/ derm cream samples. Pur Minerals foundation, original formula.Night: Cerave face wash and Clarisonic every 3 days or so for exfoliation.Internally: 40mg of Accutane started 3/16/13! 80mg started 4/15...DONE 8/19/13! OTC bcp blaahhh:/ Try to eat as healthy as I can and balance stress levels.
Please let it stay!

Oh wow that's not bad! What pharmacy is that? Mine was $36 at Walgreen for 30 :/

Morning:Cerave foaming face wash in shower. Moisturize with Cerave/ derm cream samples. Pur Minerals foundation, original formula.Night: Cerave face wash and Clarisonic every 3 days or so for exfoliation.Internally: 40mg of Accutane started 3/16/13! 80mg started 4/15...DONE 8/19/13! OTC bcp blaahhh:/ Try to eat as healthy as I can and balance stress levels.
Please let it stay!

Morning:Cerave foaming face wash in shower. Moisturize with Cerave/ derm cream samples. Pur Minerals foundation, original formula.Night: Cerave face wash and Clarisonic every 3 days or so for exfoliation.Internally: 40mg of Accutane started 3/16/13! 80mg started 4/15...DONE 8/19/13! OTC bcp blaahhh:/ Try to eat as healthy as I can and balance stress levels.
Please let it stay!